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tv   Discussion Focuses on Womens Health and the Zika Virus  CSPAN  August 5, 2016 2:03am-3:08am EDT

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women and families at risk. make no mistake, we have the tools to quite zika. what we lack is a congress with the political courage to do right by the american people. today you will hear from a distinguished panel of public health experts and advocates who are fighting to ensure that women and families have access to the services they need in the face of zika. their discussion will examine our efforts to combat this crisis and why women's health care must be an integral part of any effective zika response. first we will hear from someone who has been at the front lines of the crisis, dr. jewell mullen as the principal deputy secretary for health at the department of health and human services, dr. mullen has helped coordinate the administration's response to zika at home and around the globe. we are thrilled to hear her and site this afternoon. please join me in welcoming dr.
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mullen. [applause] >> good afternoon. i would like to thank mira and the entire cap team to be a part of this important event i want to thank you for the introduction. especially appreciate this convening because we are discussing an ever important topic, ensuring access to maternal and reproductive health care at a critical time, the zika outbreak. the disease is characterized by transmission by both mosquitoes and sex that has associated potentially severe birth outcomes. speaking from my new, almost
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seven months perch as a federal official, i want to share that as a physician and public health practitioner, i'm speaking to you from both of those positions knowing my words are those of a person will always be herself as a doctor first. people who only know me as someone who works in government, asked me, have you ever been a real dr.? i assure you, from the way in which i approach my work, that i still am. to know that i mean it and understand when i say i really appreciate this meeting and your work, because what you do is so much closer to the people, the community, and the patience than i am at this point in my career. for the administration, so much of the work and progress of the
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past several years has been rooted in the belief passed down from generation to generation that we can continue to strive toward equity. we can work together to level the playing field for all americans. we can give all of our sons and daughters, our families, the opportunity to grow and thrive and succeed. it's at the heart of that. the the progress is at the foundation of our country's values. we know that health is the bedrock that forms the foundation. you don't have to look far to see the results of that incredible work of the past several years which now includes having more than 20 million more americans who for the first time have access to coverage for themselves and families. work that has led to a more than 50% decline in the uninsured rate for african americans and a 27% decline for latinos. today, today, women can no longer be denied coverage for a
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pre-existing condition like childbirth. we also know there is a lot more we have to do. and even more sometimes when we think about african-american and latino neighbors who are less likely to have access to health coverage and access to care. zika challenges us to mobilize around that reality. while women have improved access, we still have work to do for women's health knowing that women's health is far more than reproductive health but that we can't separate the two. progress on women's health is a comprehensive approach focusing on health and well-being for all women. daughters, sisters, grandmothers. two months ago at the white house united states of women summit were women from all walks
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of life came together. they said by working today, we can change tomorrow. i was fortunate to moderate a panel on unplanned pregnancy. in in that conversation, there were many reminders that i wanted to share briefly for today. in that conversation about unplanned pregnancy, we had to remember that what we convey to women and sometimes i say women and teens because i don't want us to think about one population we are addressing. we want to convey things in a way that addresses the needs and desires an understanding of the people that we serve. that conversation we had was informed by panelists from new york city and sierra leone among others. the diversity with which we need to approach that work to achieve equity is key. i have been able to observe in
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the work we have been doing on zika what that means to address maternal and reproductive health with equity in mind and because of the work i have done in puerto rico, to understand that when you are addressing these issues for populations in which the economic conditions can far outweigh the concerns about a disease for which four out of five people infected have no symptoms, the conversation requires true information and informed decision-making for an individual are needing to be informed by the insights that everyone at the panel will will share today. i want to stress that because one of the things i understand
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working at the federal level is that with all of our expertise and science and policy guidance, that is what it is. it's work that we do on behalf of populations. what has to happen with that work is it has to be translated to be useful for the individual people who need to be able to make personal decisions for themselves. in this case, around reproductive health. i know as a physician how much that relies on shared decision making conversations with clinicians who understand, who have the information required to be able to help women make those decisions. some of the work we have done at hhs in response to zika have
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been investing more than $300,000 in emergency funding to our title 10 programs in puerto rico to expand access to contraception. we have been doing training. this is to ensure that our work with partners is culturally and linguistically appropriate. and to ensure that our services really reach those in need them most. at the office of population affairs, they released a toolkit for providers for counseling women. we are also working with states, territories, tribes on steps they can take to prevent and respond to zika. alongside that health care work, we are sharing advice on the best ways to control mosquitoes, working to improve diagnostic capacity and to keep the blood supply free of zika.
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we already mentioned vaccine development and improving diagnostic testing. underneath all of that, what might be most important is the hard work that is done every day to improve our communications , an especially important technical and human skill for everything else that needs to be done to equitably ensure access and enable women to make the decisions they need for themselves. we are working with a number of partners from women's access to effective contraception. as we do all of this, i also understand the limitations of our reach on the federal level which is why it's so important for us to continue to partner
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with you and to take your feedback so that we can continue to be better at her effort. -- our efforts. but we do need to work with you to spread the word about zika, how it's transmitted, how pregnant women, women of childbearing age and actually everyone can protect themselves. and we need ongoing advocacy for our communities, for us to have the resources that we need to implement not just mosquito prevention efforts and contraception efforts but sustainable improvement in conditions which, in addition to helping us address zika in the long run when we talk about disparities and equity, can make many more kinds of differences in the lives of people along the way. thank you for your work. thank you to the panelists for
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what you do and i look forward to our ongoing partnership. [applause] >> thanks to both of you for setting the stage for this important conversation. i'm a senior fellow at the center for american progress. i i will be moderating the panel discussion portion of today's program. we have an impressive group of women's health experts here on the panel today. i will introduce them briefly but also encourage you to access their full bios online. first
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first, in the beautiful red dress, we have the senior director for government relations at the national latina institute for reproductive health. she was responsible for the organization's washington dc office and oversees all government relations and policy advocacy work. prior to joining the latina institute, she worked as public policy director for planned parenthood affiliates in california. coleman ine claire her seventh year as president and ceo of the family planning and reproductive health association. before joining the frock, she served as president and ceo of planned parenthood before that in new york. she has held a number of positions in the united states house of representatives including chief of staff and legislative director for appropriations committee ranking member nita lowey.
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have dr.d we christopher zahn. a retired air force officer, and member of the armed forces district, he received his medical degree from uniformed services university and is a specialist in comprehensive obstetrics and gynecology and has been practicing for 29 years. before joining acah he served as a physician and the department of obstetrics and gynecology and pathology at walter reed national military medical center. last but not least, we have latonya. she joins planned parenthood federation of america in she is 2011. the executive director of planned parenthood global and vice president global. in this role, she sets the course for the international engagement on all international
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issues and, prior to joining planned parenthood, she worked for the united nations children's fund as well as the u.s. agency for international development. thank you all again for being here. the first question i have this afternoon is directed to all of you. i wanted you all to describe how your organizations are working to address zika. let's start with claire. >> thank you. the national family planning and reproductive health association is a membership association in all 50 states and several territories. we represent nearly 800 institutional providers of family planning and sexual health care nationwide so that includes 33 state governments, 15% of the nations federally qualified health centers and 80% of planned parenthood affiliates as well as many other private not-for-profit providers of family planning. we are working o approac the first is in service
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delivery. the federal advisory around how we should address peoples concerned, women and men in health services, has led to concern and confusion in the field about how to translate guidance which hasn't moved as -- has moved as new information has come to light to individual patients who come in with concerns. we have a team in texas today meeting with title 10 family planning grantees and their service delivery network to talk about how to translate the guidance of coming from the feds and local health department into practice. how do you operationalize preparedness and what do providers and local communities need to know today in order to be appropriately responsive to the field? we also work in advocacy and communications raising the voice and concerns of this network. we we have about 4100 health center sites around the country in governmental units, private
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not-for-profit units which are working to interpret this guidance and operationalize it for their community and to community awareness and make sure they have supplies on hand. it's important for us to participate in the coalition effort to call attention both from the administration and the congress to the pressing need for resources. >> anne marie? >> the national institute for ,eproductive health and justice it is the only latina national organization that represent 28 million latinos and their families. we do it through reproductive justice. what we do is to full. a lot of what we are doing is we have community mobilization that works in teams in new york and florida, in texas and virginia which also happens to be the hotspots where zika is taking place. a lot of our work right now is working with the community and trying to answer questions and
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trying to hear what their concerns are and what their needs are. then relaying that backup to d.c. which of the second part of our work which is the advocacy and lifting those concerns and addressing them and putting pressure on congress, for example, to move forward with emergency funds. >> thank you. >> it's a pleasure to be here and thank you for having this conversation. it's important for us at planned parenthood because we have the privilege of serving one out of five women in this country and over one million people per year in latin america and africa. for for us, it's incredibly important to keep women at the center of this debate around zika. on a normal day, women who are marginalized in parts of the country whether its geographic or parts of the world where they are not receiving services, they have unmet needs we are trying to address on a normal day. in in latin america in particular,
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the rate of unsafe abortion is startling. we were talking earlier this week with our colleagues in the government about the average 15-year-old in lin america, their initial sexual entrance was through violence or rape. these are women who when we, when i later start saying why don't we just wait to get pregnant while we figure out how to handle zika. they can't do that. it's very important that women remain at the center and we take take the caution from who and cdc that reproductive health has to be a huge part of the response amount for our work is centered. >> thanks very much for the opportunity to be here. acah is slightly over 50,000 members of obstetrics and gynecology and this area is of special interest to us.
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this is the first time, it's a unique time, it is the first time when there is a mosquito borne illness whose primary impact his birth defect. never before seen. it's an incredible time to be involved in women's health care. our major goal is primarily clinical. we are in daily contact with the cdc. we work very closely with them. we try to spread the message and information the cdc develops. i'm sure everyone is aware of these guidelines and they can quite frequently. we have updated our guidelines probably six times in the last couple of months. the most recent one came out last night to advise and not surprisingly, when there was little information known in the beginning, the guidelines were relatively brief. now there is more known but
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clearly, we know far less and the guidelines are much more expanded. therefore they are challenging , to understand and implement. the implementation pieces translating those guidelines into practice in the trenches. a a patient shows up who has been exposed to have traveled somewhere in what to do and how to get the testing done and how to interpret the testing and advise her on what her risks are and what the prognosis is as best we can and how to further manage the pregnancy. we work very closely with the other women's health care organizations, nurse practitioners, midwives, family practice and anyone involved in women's health to try to get this message out as much as possible. we are involved in advocacy not only for the funding issue but also access to health care and reproductive rights, etc. there are two populations, the
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women who are pregnant or planning to and their aspects and clearly, there is avoiding the pregnancy and to paraphrase dr. freeden said we don't know how to prevent zika but we do know how to prevent pregnancy and we need to make an effort to do that. >> thank you. can you walk us through the standards of care in a zika related case for to attrition's for pregnant women particularly? >> i should have made more copies but i have our most recent practice advisory. generally for women it varies , based on whether the person lives in an endemic area versus has traveled there. unfortunately, as of the last week or so, we now have an endemic area on the mainland. for people with the majority, there will be those people who travel to an infected area.
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there are guidelines as to who should be tested and what type of testing should be done. it has gotten a little bit easier with the most recent guideline. there is a division between whether they have been exposed within the first two weeks or it has been after two weeks but before 12. there are guidelines as far as what type of testing should be done in the early exposure. it's a combination of molecular testing done on both the blood and the urine specimen and, depending on the result of that, a follow on test looking for anti-bodies is done. in peopleof flip exposed beyond two weeks. depending on the result is how they are managed. if the woman test negative and she is asymptomatic, we would generally recommend an ultrasound to make sure there are no abnormalities. if that is normal, they are
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cleared for the most part. for those who test positive, it's a more intensive surveillance looking for abnormalities. i can keep on going for three hours. [laughter] going back to the issue about what we know, we know that 80% of women who are exposed will not develop symptoms which makes it incredibly challenging. we also don't know that if a woman gets infected, what her risk of transmission is. we don't know how many actual babies will be infected and the rates that have been reported range from 1-30% which is huge. secondly, we don't know if there certain women and babies that might be at higher risk of getting infected compared to those who don't. there might be underlying immune profiles or other cofactors that may play a role into how that maps out. for the women who are asymptomatic but exposed, how they develop disease. the other is the time course. we
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were used to think based on some of the initial data that women were at higher risk of having an infected fate as if they were exposed in the first trimester. there has been subsequent reports that refute that and women can be exposed later . one of the script aspects of this, clean note their basic science research that has been done that and a lot of infectious diseases, the damage that occurs in whatever organ system is can be related to the infection and the immune response. we know from some data in zika that it can directly attack brain cells, the neurons in the brain. one of the real fears and a clear unknown is that even an infected woman with a normal baby that does not show symptoms, we don't know that that virus is not going to continue to attack the brain cells of the newborn after birth. we have no idea what those
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developmental abnormalities may or may not be and what the risks are and what the percentage will be. one of the most important aspects of everything we do is the registry the cdc has created to follow these children after birth to see what happens to them down the line. >> thank you for that. i want to shift things and talk about the the title x family planning program which claire talked about. as important as the title x program is for women, it's also been a big topic on the hill. as as well as in terms of making sure that women have access to family planning through title 10 clinics. can you talk more about how ofortant title x is in terms access for family planning for women? >> at first, i would love it to
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be more central. neither the president possibly -- original quest for emergency spending which came about two months before the cdc confirmed causality and all of the negotiations that have happened throughout the spring added additional sources for the planning network. let's talk about title x briefly. it was enacted in 1970 under richard nixon and is intended to provide a network of direct health services as well as support for poor, low income, uninsured or underinsured people across the united states. today, today, the network has about 4100 service sites in all 50 states and the territories and d.c.. we see about formally and -- 4 million people. to put that in perspective, we estimate that about 20 million women of reproductive health agent meet funding in order to access the contraceptive supplies and services they need. noon i
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we are meeting about 1/5 of the need in the title x network. it is important to note that title x must see patients without regard to their ability to pay. that is true of all public health service act programs. we must see people without regard to documentation or whether or not they can prove citizenship. these networks are providing direct contraceptive care, counseling, pregnancy testing fci screening and treatment as well as services that support people who want to become pregnant. support people who want to achieve pregnancy and that includes basic fertility screening as well as providing service to help people event tennessee. this is a network that is a safety net for the united states. title x centers are not just a place for people with no
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insurance. folks with insurance water outdoors everyday and folks with medicare walk through our doors everyday. the funds subsidize the care for people who have no other pay source. these are health centers as diverse as the one in dallas which operates outpatient women's health center at 33 state governments run their title x networks in mississippi, florida, alabama, north and south carolina as well as states , these are vermont states where the title 10 money goes for the state government and they authorize the network. throughout these networks, people are being seen regardless of their ability to pay for it what we need is a drastic infusion of funds to be able to afford first the staffing necessary that is trained and ready to do a wide variety of contraceptive counseling and methods and that's important for long acting reversible methods
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of contraception. we need the funds to actually buy supplies and have them available same day on-site all across the country but particularly in the endemic areas. and we need funds to support the community awareness and partnerships we are being asked to serve. we are being asked by the fed to connect with wic programs because that population is often one we see in title 10 to make sure that the people coming in for wic services can get an idea of what's available in title 10 but there's no funds to do community education or partnership development or awareness. the network has taken $41 million in cuts since fiscal it's a network that has 2010. lost enormous capacity, lost 1.1 million people out of the networks and close health centers and laid off staff. i came from providing services and i did the rounds of layoffs
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in three years. you cannot bounce back when the crisis arrives unless you have the money to put the people into place that make these services possible. >> from what you said so brilliantly, title 10 has an important role in communities. it's already underfunded in terms of any. terms of the need. also when you think about a public health concern like zika, you will have even more people in need of access to services through title 10 clinics so thank you for that. let me shift things to anne marie. i would love for you to talk about the potential impact that zika could have particularly on the latino community. it was something that dr. mullen touched on in her remarks particular how communities of color could experience a disproportionate impact when it come to zika so please talk about that.
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>> thank you very much. i will echo a lot of what has been said. we rely on title 10 clinics to access care because we have a diverse community. roadblocke a lot of and ability to access care. are uniquelys that impacting the community is just education and competent care. my earlier remarks i was saying that we hear from people on the ground and one thing we hear constantly is that there is very little information right now going to the community. it is hot and cold. seek is really dangerous or will not impact me at all. there is a desire to learn more. know been requests that we but theythe ability
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don't have the access to those training to learn more about zika and what it can do. right now with the community is: the families in central america and trying to find out what they know so they know what to do here in the united states particularly in the endemic areas. there has been cuts to title 10 clinics but we have not seen the aca fully realize. in states where we are focused in like florida and texas, medicaid expansion is not happen there and it's so important so folks can have access to care if the clinic is open. i can keep going on the impact on how there is limited access, limited education, and limited resources and that is impacting our community. we have a lot to do.
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>> thank you for that. you mentioned florida which has been in the media and in the news over the past couple of days particularly for new cases of locally acquired transmission of zika from mosquitoes. one of one of the things i wanted to mention about florida is the fact that florida has not expanded medicaid leaving lots of people without access to health services they need. and also there over 2 million women there who want access to contraception and contraceptive services that don't have it so there are issues outside these new cases around local transmission. it's the fact that access to family planning and contraception is limited for some women in florida. i want to shift things a little bit and talk about the international context a bit. as as most of you know, the olympics are set to begin in rio
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tomorrow. there has been some conversation about whether or not it has been safe to travel to rio particularly with the impact of zika there. i want to talk things over to latonya to talk a little bit about brazil and the context of zika. particularly women in the country. >> thank you. i will pick up where many of our panelists were coming from. zika will highlight of public health gap. we can talk about that in our country and understand where they are and were marginalized women and women who don't have access to health facilities will land. but think about that from the aspect of a developing country, even a middle income country like brazil where there is a host of communities, particularly women, even afro caribbean women in brazil and
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other very special communities in that country and countries around latin america, they don't have access on a normal day to family planning, information about sica to doctors even. where as we know that will be necessary as we seek to address this issue. when we think about what women will need for zika and to deal with this, we know they will need more access to contraception, not less. we look at where the funding is going, where the emphasis and the communication around mosquitoes is going. i am a little worried that women in brazil and other countries in latin america are not going to be as prepared and ready for this. we have seen that i think. i i think the trend will follow that if we are not able to operationalize this in those countries.
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of oure perspective partners we work with in latin america, it has been very clear that we have to do more of the same kind of work around family planning. we have to do a lot more around education to communities. it's not just in the u.s. think about women who every day have to deal with the complexities of their lives, having to think about this and not sure and not receiving information, no targeted services or advocacy towards them and lots of leaders talking about the issue but not much funding going toward it other than for mosquitoes in research and most of that is coming from outside those countries. i think it's crucial for us to think about, again, women being the center of this. when you think about that, how do you get information and services out to these women? how how do you increase their access especially with sexual transmission where people hear it in the news but they are not
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quite sure what it means. is it the same or not? giving people the information they need to see for themselves what they need. i think that has to be from trusted providers like planned parenthood in the u.s. but the hundreds of partners we support in latin america. these are the people that women could do anyway. we have to make sure they are provided with the resources to be able to continue to have that conversation with their clients and get that out into the community to the various community-based programs we run. >> that's an important point. another thing that sort of comes to mind when we talk about underserved communities is how do we get information to those communities. mentioned, the latino community, there are people that are not even getting information and it is not been translated into spanish. how do we reach the heart of these committees, especially when we are sitting here in rdc bubble talking about sica and
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what these communities need. a young woman in southeast d.c., what does she know about zika and how she can get information about transmission? >> from the international perspective, we have to look to organizations already doing it on other issues. there are other issues. i think about africa and ebola and malaria and the hiv-aids epidemic. there are many community-based organizations dealing with similar public health crises. we cannot act like they are not there and just say we need to go look at mosquitoes and a taxing. we have to lift up those limitations. planned parenthood as many partners around the role that do this work every day in their communities. they are far-reaching communities outside the major cities of most of the countries in latin america. we have to support organizations like unfpa who is there every day doing this work and have a particular role but they are getting less funding than ever
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before. we have to think about international family planning that is getting less money than ever before. it's here and we have to address these issues but we are not thinking about how to support and strengthen those structures and partners already in place and we need to do that. >> that into the communities go to. that is to the trust. >> you said earlier that zika is an example that highlights where we have gaps in care and caps off of access and gaps of services. we know what to do to prevent an on -- unintended pregnancy. we should dedicate those resources and build upon them instead of cutting them which is what we are seeing happening. looking at the infrastructure, building on it and going back to what you have said which is there are many community-based organizations including us who are on the ground and are already trusted for people to
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turn to. we need the resources to give them the information. i think that is a key element to what we are doing. >> right. you mentioned resources. we we talked about the lack of moving forward on the terms of its funding from congress. the request was made several months ago by the president, $1.9 billion, to exist -- to address sica transmission and the u.s. and abroad. what do we do while we are waiting for congress to appropriate the funding we need? >> we can't wait. there has been some effort from administrative agencies to move money that was available. for the rico got $300,000 in emergency money in that money
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april. directly went from title 10 into the grantees in puerto rico. it's important to underwrite their efforts. the rate of unintended pregnancy and puerto rico is criminally high. women do not have access to methods at a much greater rate than we see in the mainland u.s. so $300,000 was a drop in the bucket. the system they were able to put that money righties. there has been a lot of emphasis on training. it's not unimportant. that's getting the pipeline together. the notion is that there are countryces in the especially in governmental , health systems or the local health department is family planning on monday, infectious 's disease tuesday, the school nurse on wednesday, back, local health apartment on thursday because the local health department is doing everything. these are not networks offering five day access to
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contraception. when you wind up in a crisis in a governmental family planning system, sometimes delay is because we don't do family planning until next the notion monday. of trying to be ready every day for a patient who may come to the door says they have been traveling and are exposed and are worried. what do i do? so we can meet their needs immediately. that's what we have been doing without any extra money. i would love congress to stop the shell game over existing resources. there is no way we can fill the gap in public health in the u.s. without coming to a reckoning about how much we have destroyed the public health infrastructure in the united states. it's not just family planning, it's also true for stds. we zika is a sexy transmitted infection. we lost 30% of the capacity and
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a sexually transmitted disease system in this country due to funding cuts over the last six years. this is not a battle ready public health infrastructure. it's unfortunate that it takes a crisis to draw attention. in the past, this country has been able to pull it together in crisis. this is a place where we have stopped dead in our not making progress in the face of a crisis. >> the other thing to highlight is it is more than just having providers and supplies to provide contraception. that's based on the assumption that 100% of the women will want it. we have cultural aspects that we need to consider. to highlight puerto rico, the unplanned pregnancy rate is incredibly high but some of that is cultural. they just don't believe in contraception and some of it is religious background. we face some of the same issues in the mainland u.s. so it is
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critical that we get the importance of the education out that this is a public health crisis and contraception is not just a pregnancy prevention because of having sex. it's prevention because of this incredible illness that can where the unborn fetus. peace, certainly looking from our perspective we , have to educate our providers to get the word out and talk to their patients and work on the local communities but we've got to educate the patient's best what the risk really is and try to address some of these cultural and various misperceptions about contraception and the dangers. we've got another battle to fight as well. >> it also comes home that notion of institutional racism in our society. when we talk about building trust people who are in the , community, whether they are an institution providing health care or are a community
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resource, this is a place where people go to trust. it's not going to be earned in a crisis. there is concern in puerto rico that they are being experimented on for prevention. if we are not honest about that -- if you not honest about that, if you don't go into that conversation saying we recognize there has to be a reckoning then there is no way we can engage patients appropriately to make the decisions based on the risk that are right for them and sensitive to their needs and respect their autonomy. >> think about it also. to your point about education, think about women who think about these things on unwanted pregnancies. think about the ones that want pregnancies. it's impossible to believe that every woman is going to say, i will take off for a year when it is time for them to get pregnant. we have to get information and have to provide services and
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medical facilities for women who do want to have babies even in an endemic area with zika. we're we're just highlighting together that the public health infrastructure and the resources that go into this under zika have to be thought about there is no time for politics. serious. it's something we need to do soon and it should have been done before. >> to build on the public health infrastructure, sex education is is a huge component, that also recognizing that not everybody has the ability to access care because there is a policy in place like undocumented individuals cannot purchase into obamacare. they also cannot purchase it along with the help of subsidies they can't have affordable health care. we have to look at all the components to make it battle ready. i would be remiss to say in terms of contraception and latinos, a lot of is not being able to get to a clinic.
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texas implemented hb2 partially and a lot of those clinics shut down. to drive to a clinic as far away and you have to take time off of work if you have a job to be able to do it. access to contraception is a huge component of white latinos -- why latinos don't have the ability to access care. i would argue that what we have known is that 96% of latinos who are catholic say they use contraception. we need to debunk the myth about our community about why or why not we're using contraception. that is part of building this public health infrastructure so we can respond to emergencies in a timely way like sica. i will add, and we will deftly get to questions from the audience after this last point. the bella bond the point -- build upon the point of restrictions and policies that
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keep folks from accessing health services, a lot of the states, the cdc has estimated could see an uptick in zika related cases. those are states that have highly restrictive abortion laws. access to safe abortion should be a part of the full spectrum of reproductive health care for women in the situation. it' with that said, we will pass things over to the audience for questions. the floors open. go ahead. >> my question is around the last point. it's about access to safe abortions particularly if zika cannot be diagnosed until the fourth month. in so many states, access is
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only for the first trimester. would you comment on that and also the issue globally? >> i can quickly talk about the fight for safe abortion continues. what happens here is we have been talking about these issues for a long time so whether it is zika or some other kind of issue that a woman has to have when she makes these decisions with her doctor, it is very clear that we have to ensure that there is an availability of safe abortion for every woman and access to it and not her jumping through hurdles. now, weecially true could talk about texas which might be a good example. there is no clinics and you have their soon will be a situation where it's endemic there as well.
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what does a woman do? i go back to what planned parenthood has had for a long time -- we have to be in places where safe abortion is legal and provide access to the most marginalized women who cannot get it and overseas, i think it's exactly the same thing. we probably have a bigger conversation because in many of those countries if not most, it's illegal to have an abortion period and it has to be something very serious where the country allows it in certain circumstances of health and is zika one of those? then you get into a policy question which many our partners are starting to look at now. >> i would add that all of the state policies focusing and attacking abortion, what is happening is limiting the full spectrum of comprehensive reproductive health care would also impacting access to care. your closing down clinics like texas. florida has passed a bill which
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has not been implemented but it would defund planned parenthood. that is a huge concern. you see the trickle impact and how it impacts people's ability to have full autonomy of their bodies and therefore cannot protect themselves when things like this happen. we see an onslaught of this. forefront to fight these state-level laws that are negatively impacting women's care. >> right here. the one in the back. >> had there. -- hello there. i feel very concerned for the young women in texas and their access to abortion. my question is to you, sir. as the position. procedures a medical
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and i would imagine between a psychiatrist and an obstetrician, if a woman's fetus is claimed to have, if evidence indicates microcephaly, certainly in abortion would be medically necessary if not for the emotional health of the family, etc., do you follow? . it's a difficult question. is a difficult predicament. thank you for reading between -- and has beennd said, we certainly support as an organization as well as our providers for the raw range of -- for range of reproductive care available which includes abortion. part of the challenge has also been when a woman manifests these findings by ultrasound, it
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may be late in their pregnancy and there are clearly state laws that impact the upper limit when they can be done. that is a separate problem. your point, i don't think i would use the term medically necessary. the determination is it should be an option. there should be an informed and shared decision-making process between the patient and their provider. it's the patient that ultimately make that decision. i don't think there would be any clinician that would say it's medically necessary you terminate this pregnancy for whatever reason. it could be a genetic abnormality or chromosomal or a congenital defect or even a and -- a lethal defect after birth. we don't tell patients that are going to die after they are born. as quit a patient's decision. there are women who want to know so they can prepare to take care
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of an infected infant. there are women who choose to terminate. it is the patient's choice after a fully informed decision making process. and time for her to process that and talk with family and her support system to make that decision. >> we have time for one more question back here. thank you so much. one of the questions i wanted to ask is about making sure women have the information they need. supporteri'm a strong of women having access to contraception. my question is more of a technical one. the cdc has been putting out guidelines for women who are exposed or testing positive for zika. when they might give information about potential problems for the fetus.
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initially they had been saying 28 to 30 weeks is when they might be able to detect. some information that it might be sooner. i was wondering if you could comment on the state of the research, when women are getting information. biters, is it a training issue? or is it really just dependent on individual pregnancy. >> the unfortunate thing, this goes back to what i said earlier, there are far more in unknown been known. there is no answer to question. even in those patients, the little did out there, presumably infected during the first trimester. when it is manifested in the fetus, it is a wide range. there is one case report where, i forget the exact timing, it
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was roughly around 19 weeks and all caps on was normal and three weeks later the fetus was infected. we don't have the ability to counsel women that even if she tested positive to say, first of all, your likelihood of developing the microcephaly is this, secondly, even if that were to happen, how long it might take to develop. unfortunately difficult. >> and the access to care. the stage of pregnancy for many of us have gone to this where you are not getting regular ultrasounds. the knot indicated that bested the pregnancy. you are talking ahead to access resources much more often. though the difficult even insurance context because insurance has limits how often and the expectations.
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in these situations, we are going to be scrambling to figure , how does get access it get paid for etc.. i'm qualified to speak to that part of this consideration. regardless of how much money you have, you will be in the situation were known can really tell you how often testing will be required and i think that is also what we have to bear in mind. --internationally, >> even in the context of florida, there are new guidelines asking women to get tested for sycamore often throughout their pregnant too. insurance coverage has also been an issue, even in that context. we will continue to talk about this issue and i thank everyone for being here today.
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this was such a good panel and conversation. i also want to thank dr. mullen. and dr. berger gave opening remarks. cap will continue to work on this issue and think of new analysis, especially around the house -- how zika will disproportionately impacts low income communities. thank you all for being here. [applause]
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>> more road to the white house coverage continues tomorrow. hillary will speak at the national association of bl ack journalists at their national convention. and in the evening, it is on to green bay, wisconsin, where donald trump will hold a rally for his supporters. that is live at 8:00 p.m. eastern on c-span. >> this week, our road to the white house coverage takes you to the green party political convention in houston. on sunday at 9:00 p.m. eastern, see the acceptance speeches for the green party nominees for president and vice president. you can use the c-span mobile app, or watch any time at www.c-span.org. >> this morning, former national security advisers, tom donelan and stephen hadley, sat down
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with politico to discuss key national security concerns. they touched on the recent democratic national committee e-mail hack, donald trump and hillary clinton, and combating isis. this is just under one hour. thank you all very much for being here this morning. early postconvention playbook record. i'm jake sherman and is my playbook co-author anna palmer. we would like to thank all of you that are here. those of you watching us live on c-span, thank you. we are thrilled to have two former national security advisers, thanh donnellan and stephen hadley joining us. hacking, allrity, the crazy and wild things happening in this world.
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before we kick off today's program, i would like to thank bank of america for the tremendous support of the playbook referenced -- breakfast. bank of america has been a partner for many years. the were just with us at 2012 and 26 team conventions and all across the country at our growing playbook series. >> before we get started, we want to remind everyone to tweet questions. j kathy ipad. playbooklive. without for the delay, please jobless -- join us in welcoming to the stage our honored guests. [applause] >> thank you. welcome. >> good morning. >> all right. let's get started with really what drove the conversation and i think got you in the church today, the hacking of 20,000
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e-mails from the democratic national committee. says itaid the campaign is russia. d.c. this any evidence that this would happen with you as advisers at the white house? >> i think tom probably somewhere bit. crilly -- clearly state parties hackbeen using cyber to increasingly record numbers. the concerns have been in the country with iran and north korea and china. fora has done it not just traditional intelligence collection also to steal basic corporate secrets and intellectual products to -- property. it is not a surprise that at some point it would migrate to political arena as it is done. the intelligence i think is still mixed.
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everybody seems to think it was russia that did it. there is a separate question of who released it to whom and when and how. we need to sort that out. it is a wake-up call. we have talked about the need for hardening the critical infrastructure of the country. you have to recognize that our political system is part of our critical infrastructure and all the next -- surrounds it is the critical infrastructure. we have to get busy and protected in the same way that we of been increasing and protecting our banking system. it that at the wake of call. shame on us for not having hard that's. nets.d >> i agree. the vulnerability of all of our systems has become more digitized. our commercializing government functions. we need to take a hard look at , particularlys a
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election results as a because more digital. there's a real vulnerability. with respect to russia, there is no doubt that russians engaged in a cyber threat. but from the russian federation and from sponsored entities. support their operations. steve said there's private dncor companies that fit systems were penetrated by at associated with russian intelligence. and the fbi is looking into that. to the effectents that they don't engage in these activities. they don't engage in cyber or political entry. . those are wrong. we assume seen along and -- long history of interference. we have

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